Dehydration occurs for many reasons: laxative or diuretic abuse; decreased intake of glucose, protein, and electrolytes; refusal to drink water; as well as excess consumption of protein or caffeine intake. Restrictive eating patterns can cause abdominal pain and bloating. Many repairs are often needed before the system begins to work optimally. Low caloric intake slows down and delays the emptying of stomach contents leading to nausea, slow digestion, and constipation.
Both restrictive eating and low caloric intake can leave you feeling fuller with less food. It is both normal to begin to feel hungry or to feel excessively full at this point. Hunger may become obvious once your body starts using and requesting more energy.
However, depression, stress, and anxiety can still be potent appetite suppressants even as your body demands food. When you begin to eat more there is no way to direct the allocation of energy to a specific body system.
Individuals often have the experience of fearing that each new uncomfortable physical symptom will never cease. It follows that this occurrence is often filled with high anxiety and can be one of the most fearful moments of the entire recovery process. During the weight gain phase of refeeding, three types of weight gain occur: continued restoration of normal fluid balance, lean body mass gain, and body fat gain.
Research studies consistently demonstrate that weight gain from body fat is only part of the equation. To create new body fat there must be an excess of calories. Each day during weight gain, important and small amounts of lean body mass and body fat gain are being created. Simultaneously, daily fluid shifts of between 1 to 5 pounds are occurring. It is impossible to know which aspect of weight is increasing on any given day.
This is an important area to practice tolerating the discomfort associated with uncertainty. Variations in fluid weight can be more pronounced during the weight gain process.
Fluid fluctuations relate to daily sodium and carbohydrate intake, the amount of fluid necessary to excrete the byproducts of repair through urine, as well as fluid retention to support tissue growth. During the weight gain phase, individual appetite experiences can vary dramatically. Fullness often can get confused with gas or bloating. Increased gas production occurs for many reasons connected to food production and healing. Many report wild swings between insatiable hunger and profound fullness.
Some may experience both ends of the hunger spectrum in a course of an hour. Hunger signals are unpredictable and intense. Even on very high calorie meal plans designed for weight gain, people report hunger. In the famous Ancel Keys Starvation Study, subjects were eating up to 6, calories per day and still felt hungry or unsatisfied. Eating disorder thoughts and beliefs use the chaos and unpredictability of this phase to lure you back to the disorder.
People often spend countless hours worrying about the characteristics of weight gain. Some dive into eating disorder behaviors simply as a way to cope.
Others create rules to apply to the weight gain experience, choosing high calorie foods to speed the process or favoring desserts that are no longer off-limits. The least eating disordered responses to this phase are to choose foods you like, challenge the fears about particular foods, and always strive to refrain from controlling the process.
Being open to information from clinicians about the refeeding process can also help one put things into context and simultaneously be reassuring that discomfort is expected. Tolerating the uncertainty thus becomes a critically important recovery tool. Sometimes it is impossible to avoid abdominal discomfort. Following a normal sized meal, you can often feel a tightening in your pants as the abdomen expands to accommodate food just eaten. With meal plans designed for weight gain, this experience is often increased.
Additionally, extra stool or urine is produced from the break down of food and conversion to energy thereby creating more mass in the intestines. Research indicates that weight gain will often occur first in the abdomen before it does in the legs and arms. This adaptive process occurs in order for body fat to protect and separate vital organs. One year out from weight restoration there is no statistical difference between the shapes of weight-restored individuals and those who have never had an eating disorder.
True presentations of a late-stage-pregnancy looking abdomen are very rare. Factors that reduce the risk of disproportionate abdominal weight gain include: regular periods or shorter duration of amenorrhea less than 1 year , early intervention, and relapse prevention.
Toward the end of the weight gain phase individuals on a high calorie meal plan e. Realize that you are NOT your feelings. Emotions are passing events, like clouds moving across the sky. Once you understand the link between your emotions and your disordered eating patterns—and can identify your triggers—you still need to find alternatives to dieting that you can turn to for emotional fulfillment.
For example:. People with anorexia are often perfectionists and overachievers. But while they may appear to have it all together, inside they feel helpless, inadequate, and worthless. All-or-nothing thinking. You have a hard time seeing shades of gray, at least when it comes to yourself. Emotional reasoning. You believe if you feel a certain way, it must be true. Musts, must-nots, and have-tos. You call yourself names based on mistakes and perceived shortcomings.
You jump to the worst-case scenario. Once you identify the destructive thoughts patterns that you default to, you can start to challenge them with questions such as:. As you cross-examine your negative thoughts, you may be surprised at how quickly they crumble. Developing a healthier relationship with food entails:. Let go of rigid food rules. The truth is that these rules are controlling you, not the other way around.
This is a big change that will feel scary at first, but day by day, it will get easier. Get back in touch with your body. You may not even recognize them anymore. The goal is to get back in touch with these internal cues, so you can eat based on your physiological needs. Allow yourself to eat all foods.
Instead of putting certain food off limits, eat whatever you want, but pay attention to how you feel physically after eating different foods. Ideally, what you eat should leave you feeling satisfied and energized. Get rid of your scale. Instead of focusing on weight as a measurement of self-worth, focus on how you feel. Make health and vitality your goal, not a number on the scale. Develop a healthy meal plan. If you need to gain weight, a nutritionist or dietician can help you develop a healthy meal plan that includes enough calories to get you back to a normal weight.
Getting back to a normal weight is no easy task. The thought of gaining weight is probably extremely frightening, and you may be tempted to resist. But this fear is a symptom of your anorexia.
Reading about anorexia or talking to other people who have lived with it can help. It also helps to be honest about your feelings and fears. Having anorexia can distort the way your loved one thinks—about their body, the world around them, even your motivations for trying to help. If your loved one is willing to talk, listen without judgment, no matter how out of touch the person sounds.
It is ultimately their choice to decide when they are ready. Encourage your loved one to get help. The longer an eating disorder remains undiagnosed and untreated, the harder it is on the body and the more difficult it is to overcome, so urge your loved one to see a doctor as soon as possible. And you can bring others—from peers to parents—into the circle of support.
Be a role model for healthy eating, exercising, and body image. A person with anorexia needs compassion and support, not an authority figure standing over the table with a calorie counter. Avoid threats, scare tactics, angry outbursts, and put-downs. Negative communication will only make it worse. Authors: Melinda Smith, M. Harvard Health Books.
Treatment — Tips on eating disorder treatment. National Eating Disorders Association. Anorexia nervosa — FAQs on anorexia and its treatment. Anorexia Nervosa — Includes risk factors such as body image, self esteem, and perfectionism. Eating Disorders Victoria. In the U. Please note that stories of people with eating disorders even fictional ones can be triggering to those with these disorders.
If you have an eating disorder or are in early recovery , please consider whether or not reading this story will be helpful for your recovery. If you are triggered, please talk about it with your therapist or your treatment team.
The alarm clock wakes me up and I hit snooze. I am so tired every day. My apartment seems so cold, and I just want to stay in my bed with the covers on. I am always cold. But I must go to school, so I get up to take a shower.
Immediately, I weigh myself. I do some calisthenics and then go to the bathroom and weigh myself again to see if the number changes. This tells me whether or not I can eat breakfast, and if this day is going to suck or not.
The number on the scale is low enough. I get to eat breakfast today. Glancing in the mirror, I see my naked body. I start pinching at my sides to see if the fat is still there. I hate what I see, and the voice in my head starts criticizing me and telling me I don't deserve to eat. In the shower, I notice that my hair is falling out in clumps. My skin is extremely dry and chapped. After my shower, I dress quickly. Even though it's early summer, I put on a baggy sweatshirt.
Plus, if my clothes are too tight, I feel fat. Even though the bathroom is right near the kitchen, I walk the long way around the apartment.
I allow myself to eat a small breakfast and several cups of black coffee. I need the caffeine to make it through the day.
Then, I drive to school, choosing a parking spot in the farthest corner of the lot so that I can walk further. The more calories I burn, the more weight I will lose. Throughout my classes, my mind wanders, and I find it hard to focus on what my professors are saying.
I keep thinking about lunch, and whether or not my friends will want me to meet them. How am I going to avoid eating again?
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